Since pancreatic cancer is now the fourth leading cause of cancer death in the United States, intensive efforts are needed to reduce the impact of this disease. In view of the rapid clinical course of pancreatic cancer and the grim prognosis, it is likely that the greatest hope for progress in treatment of this disease will be through prevention and early detection. A three-part environmental epidemiologic study of pancreatic cancer is therefore proposed to identify specific risk factors and possible etiologic agents and mechanisms. The first phase will describe the changing incidence and mortality rates of pancreatic cancer over a 15 year period in a defined community, metropolitan Baltimore. The second phase of this study will be a case-control investigation of pancreatic cancer patients and various control groups to explore possible etiologic factors; in particular, environmental and occupational characteristics including exposure to chemical agents and to health care environments and occupations. In addition, younger and older cases will be compared with respect to these characteristics, to determine whether pancreatic cancer in the young is the same as in the elderly. Finally, a non-concurrent prospective study will be carried out to determine whether the risk of developing or dying from pancreatic cancer is higher in patients with chronic pancreatitis than in a non-pancreatitis control group. The approaches outlined above are designed to provide the basis for modifying environmental exposures and thus developing measures for preventing the disease. Secondly, the results may permit the identification of populations which are at high risk of the disease who might benefit from close medical surveillance and intensive efforts at early detection using the newer diagnostic techniques currently being developed.